Medical Staff Credentialing Specialist - FTD

The Medical Staff Credentialing Specialist is responsible for administering the credentialing process and works under the direction of executive management. Collects and verifies data that serves as the basis for decisions regarding appointments and reappointments to the Medical Staff or Allied Health Staff. Responsible for considering all information regarding the applicants education, licensure, training, experience, current competence and ability to perform privileges requested. May also be responsible for medical insurance company credentialing.

Primary Duties

• Plans, organizes and directs a comprehensive centralized credentialing and privileging process for the medical staff and allied health professionals. The process is revised as necessary to meet requirements of regulatory agencies, TJC, Medical Staff bylaws, etc.
• Obtains and/or supervises collection, verification and processing of data for initial appointment and reappointment. Ensures the reappointment process is handled in a timely manner.
• Maintains confidentiality of all information and departmental/hospital business activities.
• Maintains accurate, timely and complete information and files for each Medical Staff and Allied Health Practitioner.
• Works with the Performance Improvement Director to create and maintain performance improvement files for each Medical Staff and Allied Health Practitioner.
• Creates and maintains an accurate calendar for reappointment of practitioners.
• Communicates in a timely manner the need for reappointment performance improvement data and other information to meet the time frames of each reappointment. The time frame for reappointment never exceeds two years.
• Responsible for full use of the Midas credentialing computer database program.
• Responsible for the archival system of files for resigned or retired physicians and allied health professionals.
• Communicates effectively with the Midas system administrator.
• Maintains effective communication and relations with practitioners, employees, other departments, administration, the governing body and the public/community.
• Assists in the scheduling, support and follow-up of medical staff committee, department and medical staff meetings and other activities and provides support as needed.
• Creates and implements a checklist regarding mandatory reporting and action items requiring Medical Staff input, approval or action.
• May attend, document via minutes and prepare agendas for the minutes of the following meetings as applicable: Governing Body, Medical Executive, Credentials, Bylaws, Surgery Department, Medicine Department, other Medical Staff department/section meetings, ad hoc Medical Staff meetings, disciplinary action Medical Staff meetings, the annual Medical Staff meeting and other meetings requiring Medical Staff involvement.
• Ensures minutes and other documents from Medical Staff committees and other regulatory minutes, such as Performance Improvement or Environment of Care, are carried forward for reporting and action at the Medical Executive Committee.
• Responsible for completion of reports, surveys and research as required for both departmental and medical staff activities.
• Develops and provides new Medical Staff and Allied Health professionals with an orientation program.
• Assists in the orientation of new Medical Staff Officers and Department chairpersons regarding required duties to help them consistently perform their functions.
• Ensures the proctoring process of new practitioners/procedures is initiated in conjunction with the Medical Staff leaders and the Performance Improvement Director or other directors.
• Assists in maintaining compliance with TJC, state and Medicare standards. Serves as an expert for medical staff regulations and standards and has a current and thorough knowledge of standards and is intimately involved in the survey preparation and visits.
• Serves as the organizations keeper of the medical staff bylaws, bylaw-related documents and department rules and regulations and assists the Medical Staff in complying with these parameters. Has a process in place to permanently track and log all changes in these documents.
• Responsible for evaluating credentialing verification organizations and maintaining high quality standards with their process and outcomes as applicable.
• Participates in all hospital-wide and job-specific safety training programs, as well as any additional training based on needs assessment. Shows sufficient and ongoing knowledge of hospital-wide safety practices and those that directly relate to his or her responsibilities.
• Answers telephone for medical staff services. Demonstrates excellent telephone courtesy and communicates with customers in a professional and appropriate manner.
• Credentials and reappoints contracted personnel as AHPs as applicable.
• Performs other duties as assigned.
• Responsible for the maintenance of physicians and allied health demographic and clinic information in the credentialing system.
• Ensure that facility and company medical/allied health staff fulfill government credentialing regulations
• Responsible for proper enrollment of facility and company medical/allied health staff with all AHH accepting insurance agencies
• Responsible for creation/ maintenance of company medical/allied health staff credentialing account using CAQH Universal Datasource
• Communicates effectively with business office for accurate/ timely claim filing
• Communicates effectively with MIS to establish company medical/allied health staff ECW accounts
• Ensures appointment/ reappointments are maintained for company medical/ allied health staff at sounding healthcare facilities.
• Communicates effectively with healthcare network credentialing specialist to ensure timely enrollment

Qualifications/Specifications:

• Education: High school diploma or equivalent required. College education preferred.
• Licensure/Certification: None required. Certified Medical Staff Coordinator (CMSC) or Certified Provider Credentialing Specialist (CPCS) through NAMSS preferred.
• Experience: Minimum of two years experience in medical office scheduling and/or medical administration/record-keeping. Medical Staff processes and credentialing experience preferred.